Cork University Dental School and Hospital - Doctoral Theses
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Item Determining competence in prosthodontics in undergraduate dental school programmes: an international study(University College Cork, 2022-12-09) Al Khalaf, Khaleel; Lynch, Christopher D.; Da Mata, CristianeBackground and aims: In an era of increased attention on patient safety, as well as increased student mobility between many countries, it is of interest to investigate contemporary international trends in the teaching and assessment of prosthodontics. The aims of this PhD project were to investigate the teaching and assessment methods of the prosthodontics domains and to determine if it is possible to agree on competency standards in prosthodontics. Structure and methods: This thesis includes an introductory chapter (Chapter 1), a narrative review of relevant educational and prosthodontic literature (Chapter 2), four original quantitative (questionnaire-base) studies to assess the contemporary teaching and assessment methods of prosthodontics on international basis (Chapters 3-6), and a mixed-method Delphi approach among prosthodontic/restorative dentistry experts to obtain a consensus on the most suitable undergraduate teaching and assessment methods (Chapter 7). Chapter 8 includes a qualitative study using one-to-one interview to explore the perspectives and opinions of senior dental academics that did not reach consensus using the Delphi method. Chapter 9 contains a systematic review synthesising the response rates in dental literature of questionnaire-base studies. Finally, a brief conclusion of the thesis was presented (Chapter 10). Results: Narrative review: there was significant divergence among prosthodontic curricula in dental schools in terms of teaching methods, assessment criteria and how student competence is determined. Quantitative studies: Our findings from the quantitative studies reinforced the findings of the narrative review; there was a significant international divergence of undergraduate teaching and assessment trends among dental schools, including the preclinical and clinical course, of the prosthodontics divisions (complete denture, removable partial denture, fixed prosthodontics and dental implants). Divergence was evident in dental schools even within the same country. Mixed-method Delphi and qualitative studies: A total of 23 senior academic experts from 11 countries participated in the Delphi study. There was a high level (92.6%, 175 statements out of 189) of consensus agreement over three iterative rounds, whereas 14 statements (7.4%) did not achieve a consensus. A total of 12 senior dental academics from seven countries participated in semi-structured interviews, it was agreed that academic professors, consultants, or specialists were the most suitable staff members to supervise students during preclinical hands-on sessions in removable and fixed prosthodontics. In addition, participants mentioned the availability of suitable patients for treatment, dental schools’ curriculum and the level of students’ skills as factors influencing the starting point of clinical sessions in fixed prosthodontics. We also found differences among the participating schools in regard to course contents and extent of teaching on dental implants. The experts suggested tailoring the curriculum according to what is expected from the graduating dentists and allowing students to observe dental implant cases before treating simple cases. Systematic review of response rate: Overall, 133 studies with 149 response rates were included. The median response rate across the included studies was 77%, a significant negative correlation was observed between the response rate and the actual number of distributed questionnaires (sample size) (r = -0.4127; P<0.001). there was an association between the response rate and the area of distribution (e.g., national or international, P= 0.0012). Yet, it was unclear whether if there are correlations between the response rate and other variables (e.g., piloting, number of questions and the journal impact factor). Conclusions: This thesis highlighted the current divergence in teaching and assessment methods of undergraduate prosthodontics. However, this divergence can be minimized, and the international harmonization of the dental curricula is highly possible by reassessing and tailoring the dental curricula. We presented a list of senior academics’ consensus statements on the teaching and assessment methods of prosthodontics. In addition, multiple recommendations and challenge resolutions were suggested and introduced. Thus, our findings can be considered as guidelines and references to develop recommendations for stakeholders involved in undergraduate curricula among dental schools worldwide and in consistence with the local dental council recommendations, which will ensure dentists with the same level of competence at graduation.Item Children and adolescents and modified twin block for Class II division 1 malocclusion compared to controls: quantitative and qualitative analyses(University College Cork, 2021-07) O'Dwyer, Caroline; Millett, DeclanAims • To evaluate the impact Modified Twin Block (MTB) treatment has on oral health related quality of life (OHRQoL), self-esteem, self-perception of aesthetic treatment need and 3D soft tissue facial changes in children with Class II division 1 malocclusion (II/1M) compared to children with II/1M awaiting treatment who served as controls. • To assess the effect MTB treatment has on family quality of life (QoL) and on both the parent’s perception of their child’s OHRQoL and aesthetic treatment need compared to controls. • To assess the level of agreement of child OHRQoL and perception of aesthetic treatment need by child and parent between groups. Materials and methods Following ethical approval, 60 subjects (31 males; 29 females) received MTB treatment (MTB group) and 47 subjects (22 males; 25 females) with II/1M awaiting treatment served as controls (Control group). At baseline (T1) and following MTB treatment/recall (T2) all subjects completed the Child Perception Questionnaire (CPQ11-14), Child Health Questionnaire short from (CHQ-CF45) and self-assessed aesthetic treatment need (IOTN-AC). Each child also had a 3D facial image captured at rest. At the same time points, a parent of each child completed the Parent-Caregiver Perception Questionnaire (P-CPQ) and assessed their child’s aesthetic treatment need (IOTN-AC). Comparisons of patient demographics were made using ANOVA and Chi-square tests. ANOVA was used for comparisons in CPQ, P-CPQ, CHQ-CF45 and 3D soft tissue facial changes at T1 and T2 between groups and paired t-tests were used within both groups. Bowker’s symmetry test was used to compare IOTN-AC within groups and Fisher’s Exact test was used between groups. ANOVA was used to test for associations between CPQ, CHQ, IOTN-AC, and 3D soft tissue facial change. Results Forty-two subjects (20 males; 22 females) completed MTB treatment (average duration 8.5 months; range 5-12 months) and 35 untreated II/1M subjects (15 males; 20 females) were recalled after an average time of 11 months (range 9-13 months). At T1, groups were similar in age (p=0.1402) and gender (p=0.2973) but overjet in the MTB group was slightly greater (p=0.0016). At T2, there was a significant improvement in the MTB group in overall OHRQoL (p<0.0001) and self-perception of aesthetic treatment need (p=0.018) but there was no change in self-esteem (p=0.144). Significant improvements occurred in family QoL (p=0.0001), in parent’s perception of both their child’s OHRQoL (p<0.0001) and aesthetic treatment need (p<0.0001). In the MTB and Control groups and at both time points, the level of agreement between child and parent perception of the child’s OHRQoL was poor with parents rating it worse [MTB group T1, p=0.0001; T2, p=0.003]; [Control group T1, p=0.001; T2, p=0.008]. At T1, parents rated the aesthetic treatment need to be greater than their child in the MTB group (p=0.054) and Control group (p=0.04). At T2, the level of agreement between the child and parent in their aesthetic treatment need was similar (p=0.262) but in the MTB group children perceived their aesthetic treatment need to be greater than their parents (p=0.019). From T1 to T2, significant 3D soft tissue changes occurred at Pogonion in the MTB group 4.26 mm (p= 0.001) and in the Control group 3.29 mm (p=0.002) but the mean difference between the groups (0.97 mm; p=0.011) was not clinically significant. Conclusions • MTB treatment significantly improved the OHRQoL and self-perception of aesthetic treatment need in children with II/1M but had no significant impact on self-esteem or 3D soft tissue facial changes compared to controls. • MTB treatment significantly improved the family QoL and both the parent’s perception of their child’s OHRQoL and aesthetic treatment need compared to controls. • In children following MTB treatment or awaiting treatment, poor agreement existed between the child and parent perception of OHRQoL and aesthetic treatment need.Item Psychosocial and physiological assessments of orthognathic patients(University College Cork, 2018) Paul Cheruvathur, Raphy; Millett, Declan; Health Service Executive, IrelandAims: The primary aim was to compare, in the RoI, generic oral health-related quality of life (OHIP14), condition-specific quality of life (OQLQ), the fear of negative evaluation (BFNES) and self-reported BMI of patients seeking surgical-orthodontic correction of their malocclusion versus those of the general population. A secondary aim was to assess the IOFTN in the orthognathic cohort and to investigate any correlation between the functional domain of OQLQ and IOFTN. Materials and Methods: Orthognathic patients prior to commencing pre-surgical orthodontics from five regional HSE orthodontic units within the RoI and randomly selected age-matched subjects from the general population were invited to complete a telephone interview. Participants were asked questions regarding general characteristics and then asked to respond to the validated questionnaires OHIP-14, OQLQ, and BFNES. IOFTN grades of the orthognathic sample were also assessed. Results: Eighty orthognathic patients (39 males; 41 females) with an overall mean age of 17.5 (SD 1.6) years and 213 subjects from the general population (95 males; 118 females) with an overall mean age of 17.8 (SD 1.5) years completed a telephone interview. Orthognathic patients had significantly higher mean scores for OHIP-14, OQLQ and S-BFNES than the general population (p < 0.001). The mean score of OHIP-14 for the orthognathic patients and the general population were 14 (SD 8.6) and 5 (SD 5.9) respectively. Corresponding group scores for OQLQ were 40.9 (SD 19.3) and 19.9 (SD 14.9), and for S-BFNES were 23.2 (SD 7.2) and 18.8 (SD 8.1). Females had higher overall OQLQ and S-BFNES scores than males in both groups (p < 0.0001). There was no significant difference in the distribution of self-reported BMI categories between the groups (p = 0.8931). More than 90 per cent of the orthognathic sample were in IOFTN grade 4 and grade 5 showing ‘great’ and ‘very great’ functional need for surgery respectively. No association was found between the functional domain of OQLQ and IOFTN categories (p=0.5530). Conclusion: Orthognathic patients reported significantly poorer oral-health related and condition-specific quality of life as well as higher levels of social anxiety than the general population. Females in both groups had higher scores than males for OQLQ and S-BFNES. There was no correlation between the functional domain of OQLQ and IOFTN.